Beyond mainstream: Making the case for fecal bacteriotherapy
Frank Myers MA, CIC

December 2011 
Volume 41  Number 12
Pages 50 - 53
  PDF Version Available!

FECAL TRANSPLANT, also known as fecal bacteriotherapy, is probably the most headline-grabbing treatment of Clostridium difficile-associated disease (CDAD). Building on the approach of probiotics, fecal bacteriotherapy entails using feces as medicine. Although doing so goes against most of western medicine's basic tenets, experts in infectious diseases and gastroenterology find merit in the procedure. In fact, at the 48th Annual Meeting of the Infectious Diseases Society of America, two leaders in the field of CDAD debated not on whether to do fecal transplant, but how...and in what circumstances.1Fecal bacteriotherapy targets bacterial interference within the bowel. C. difficile, an anaerobic, Gram-positive, spore-forming bacillus, invades and colonizes the gastrointestinal tract. Infection may precede or proceed gut insult from events such as antibiotic therapy or chronic Salmonella infection. In cases of chronic C. difficile, mainstream therapy usually fails and the patient experiences recurrent diarrhea, abdominal pain, nausea, vomiting, and bowel inflammation. Introducing normal bacterial flora from a healthy donor allows the patient's colon to recolonize with positive bacterial flora.To date, there have been just over 350 fecal transplants to treat CDAD.2 The first reported procedure for recurrent infection was published in U.S. medical literature in 2003, just as C. difficile illness rates were increasing, along with the strain's pathogenicity. In this study, 18 subjects had the feces administered through a nasogastric tube.3 Now, most fecal transplants (80%) are administered through colon oscopy. No randomized control trial comparing the two methods of administration has been conducted and published, but reported outcomes appear similar. Note, though, that methodological differences and patient selection criteria prevent either approach from claiming treatment rates as comparable, superior, or inferior to the other approach.Some clinicians claim that colon oscopy

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